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Pricey ‘breakthrough’ drugs confound Medicaid rate-setting
Modern Healthcare

Actuaries say it’s getting increasingly difficult to advise states on sound rates for Medicaid managed-care plans because high-priced specialty drugs like Sovaldi continue to hit the market at a rapid clip.

The American Academy of Actuaries is asking the CMS to give states new flexibility in funding approaches to deal with the expensive new drugs.

“A new therapy … has the potential to diminish the ability of the actuary to accurately project future expenses from historical experience because of the significant change in practice patterns and costs that such new treatments can create,” the organization said in a November letter to the CMS.